Respiration; international review of thoracic diseases
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As opposed to 'video-assisted thoracoscopic surgery' which requires general anesthesia, double-lumen tracheal intubation and single lung ventilation, medical thoracoscopy (or 'pleuroscopy') is frequently performed in the respiratory endoscopy suite using local anesthesia. It can be done by well-trained physicians, either pulmonologists or thoracic surgeons, and its main indication is related to diagnosis and treatment of pleural effusions. Also, pneumothorax can be managed in most cases using medical thoracoscopy. This article focuses in particular on technical aspects of medical thoracoscopy, including the selection and preparation of the patient, the choice of equipment, specific details of the procedure itself, and other technical details aimed at preventing complications.
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At least 40% of all patients with pneumonia will have an associated pleural effusion, although a minority will require an intervention for a complicated parapneumonic effusion or empyema. All patients require medical management with antibiotics. Empyema and large or loculated effusions need to be formally drained, as well as parapneumonic effusions with a pH <7.20, glucose <3.4 mmol/l (60 mg/dl) or positive microbial stain and/or culture. ⋯ Local expertise and availability are likely to dictate the initial choice between tube thoracostomy (with or without fibrinolytics) and thoracoscopy. Open surgical intervention is sometimes required to control pleural sepsis or to restore chest mechanics. This review gives an overview of parapneumonic effusion and empyema, focusing on recent developments and controversies.
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A T tube is an upper airway device well described in the literature which is used to maintain tracheal lumen patency. Although tube occlusion is a known complication, it can be minimized by certain precautions. Otherwise, total occlusion can result in dramatic clinical deterioration or death. Herein, we describe a new clinical entity, 'tricho-tracheobezoar', using a new term defining a hairball in the trachea, which illustrates many of the potential pitfalls in the management of T tubes.
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Multicenter Study
DNAI1 mutations explain only 2% of primary ciliary dykinesia.
Primary ciliary dyskinesia (PCD) is a rare recessive hereditary disorder characterized by dysmotility to immotility of ciliated and flagellated structures. Its main symptoms are respiratory, caused by defective ciliary beating in the epithelium of the upper airways (nose, bronchi and paranasal sinuses). Impairing the drainage of inhaled microorganisms and particles leads to recurrent infections and pulmonary complications. To date, 5 genes encoding 3 dynein protein arm subunits (DNAI1, DNAH5 and DNAH11), the kinase TXNDC3 and the X-linked RPGR have been found to be mutated in PCD. ⋯ We conclude that DNAI1 gene mutation is not a common cause of PCD, and that major or several additional disease gene(s) still remain to be identified before a sensitive molecular diagnostic test can be developed for PCD.
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Algorithms for the pre-operative evaluation of lung resection candidates with impaired lung function invariably include maximum oxygen uptake (VO(2)MAX) as a critical parameter of functional reserves, with a VO(2)MAX >or=20 ml/kg/min generally considered sufficient for pneumonectomy. Stair climbing is a low-cost alternative to assess exercise capacity. ⋯ The average speed of ascent during stair climbing was an accurate semiquantitative predictor of VO(2)MAX/kg, whereas altitude was not. We were able to identify potential cut-off values for lobectomy or pneumonectomy. Pending validation with clinical endpoints, stair climbing may replace formal exercise testing at much lower costs in a large proportion of lung resection candidates.